HomeMy WebLinkAbout383 16TH PL - Building Permits�
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JobAddress: $H$ 167H PL
Suite:
Vicinity: OUPLEX
Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construclion: V-N
Parcel Number: 42519109 Zoning:
Applicant: LEHMAN, JEFF
Address: 2415 MARGARET DR
NEWPORT BEACH, CA . �
Owner. EWING, CAROLYN PEIRCE TR
Address 2280 PEGGY LN � - �'
EL DORqDO HILLS, CA .
Contractor. 'J S L ROOFING INC .`
Address: 2415 MARGARET DR � �
NEWPORT BEACH, CA
Zip: 92663 , �
Arch :
Address: . , ' . ,
2ip:
Phone:
License:
Phone: � (949) 6463571
Zip: 92663 -
Phone:
Zip: 95762-3810
Phone: (949)646-3577
, License: 747706
Eng:
Address:
ISSUED BY:
SlaWs: ISSUED
Applied: 11/02/2005
Issued: 11/02/2005
Phone:
License:
SCOPE OF PERMIT
REROOF DUPLEX WITH ATTACHED GARAGE: T/O EXISTING B.U.FIBERGLASS ROOF. INSTALL NEW 4- PLY FIBERGLASS CAP ROOF.
; • �, FEE SUMMARY�
Plan Check ' $0 00 � ` � Calc Valuation ga eoo 00
Permit: $111.25
SMIP f2es: $0.50
SMIP Com: $0.00
Other: . $0.00
Inspection: $0.00
Total: $111.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0 �
PARKING Existina; o
Rear 0-0
Rear 0- 0
� -Reauired: 0
PLANNING& ZONING
Lefl. 0-0 �''
Left 0- 0 ,
Proposed:� 0.
_ Claim Valuation: �a,aoo.00
Right . 0- 0
Right 0- 0
�
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statules and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: This pertnit shall aUtomatically expire and become void if work is nol commenced within 160 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the Work aulhorized under this pertnit to be considered legal, such work must comply with all applicable coAes, antl all
requlred Inapeetlona and final epproval must be obtained. Failure to obtain inspecGons and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
264648 (fJ00)
WORKERS' COMPENSATION DECLAqATION: � ' � � , ' ' �
.I hereby affirm untler penalty of perjury one of ihe following tleclarations:'' � � '��� � , �
❑ I have antl will maintain a certificate of consent lo setl-Insure tor workers' compensetlon, es provided for by section 3700 0( lhe Lebor Code, for the pertormence of the
work tor whiCh this permit is issued. � � � � .
❑ I heve end will mainlain workers' compensetion insurance, as requirad by sectlon 3�00 of the Lebor Cotle, for the pertortnance of the work for which this �pertnit is Issuetl.
My workere' compensation Insurance carner antl policy number are: �
Carner: Policy Number. � � '
(This secfion need not be completed il fhe permif is velued et one hundred dollars ($100) or less.)
n I certily that in the perform�yc ihe work lo� hich this perrnit is issue4 I s�all not employ�any�person in any manner so as ro Decome'su6jeit m the workers'
compensation laws oi C 116 , antl agr � at If I shoultl become subjed to tha workers' compansation provisions ot Section 3700 ot ihe Labor Code, I shall tort�with
comply with Ihese pro � io
AppllcenY5lpnetuie: r-Date: ��'� Z''�S�
WAFNING: FAIWRE TO SE RS' PENSATION CAVERAGE IS UNLAWFUL ANO SHALL SUBIECT AN EMPIOVER TO CRIMINQ PENALTIES AND GVIL FlNES UP TOONE HUN�FED
THOUSAND DOLLARE (51 , ITI O THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I �ereby eHirm that I am licensed under Orovisio s of Ch (commencing with Section 7000) ot Division 3 oi �he Business and Professions Cotle, and my license Is in full
force antl aHacL Lic. ql '1 �� Class�a C��
v--
Contractors'Si9neture:— �e:�
� -f•
CONSTRUCTION LENDIN A NCY:. t .
❑ I hereby attirm ihat ihere is a construction lending agency for ihe pedormance ot Ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lenders Address:
Signature:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn Ihet under penalry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reeson (Sec. 7031.5, Business end Protessions
Cotle: Any ciry or county which reduires a permit to construct, alter, impmve, demolish, or repair any sirucNre, prior to its issuance, also requires the aOPlicant foF such pertnit
to tile a signed statement that he or she is Ilcensed pursuaN ro the pmvisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Divislon 3 of lhe
Business antl Professions Code) or that he or she is exempt therefrom and ihe besis for the alleged exemption. Any violetion of Section 7037.5 by any applicent tor e pertnit
subjects Ihe epplicant to a civil penalry oi not more then five huntlred dollars ($500).):
❑ I, as owner ot Ihe property, or my employees wilh wages as their sole compensation, WILL DO THE WORK, antl the structure I5 not intanded or oHered tor sale (Sec.
7044, Business and Professions Coae: The Coniractors License Law does not apply to an owner of property who Duiltls or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvemenis are not intended or oHered for sele. If, however, the builtling or improvement is
soltl within one year of completion, Ihe owner-builder will have lha burden of proving Ihal he or she did not build or improve for purpose of sale.). -
❑ I, as owner of the properry, am EXCLUSNELV CONTRACTING WITH LICENSED CONTRAC70RS to construct t�e project (Sac. 7044, Business and Professions
Code: Tha contractors License Lew doe5 not epply to an owner of property who bullds or Impmves thereon, and who Contrec(s for such project with a contrector(s)
license pursuant to ihe Contractors License Laws.).
❑ I em eaempt under sec. Business and Protessions Code for this reason:
Signature: Date:
Owner ID verified by dnvefs license. ❑ Ves ❑ No Driver's License No. Expires:
Veritication of Ownership by (type of document, I.e. - properry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTFICATON:
❑ I hereby cenify that no excavation five (5) or more feet in depth into which e person is requiretl to descenq will 6e made in connection with work authonzetl by this
pertnit, and ihat no building structure, scattolding, falsework, or demolition or dismantling thereot, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, 7�1e 8, California Administra�ive Code).
❑ As owner-builder, I will not employ anyone m tlo work which would require e permit from the Division of Indusirial Safety, es noted above, unless such pereon hes e
permit to tlo such work fmm the division.
Signature: Date:
Division of Indusirial Safery Permit Number:
CER7IFICATE OF COMPLIANCE AND AUTIORIIATION OF ENiRV: I cenity under penalry ot perjury that I have read �his application and state that the intormation given is
correct I agree to comply with all state lews and ciry ordinances rela�ing to Duiltling construction, antl authonze representatives ot the Ciry of Costa Mesa to emer upon Ihe
above-described properry tor inspecjion puryoses. I agree not to occupy or allow occupancy of any building authorized by ihis permit until final inspection.
39��
1266
200
Fixetl�5ystem Final Fire Prevention
Pool Spa Final
Final Re-Rooi �
201 Final BIocWRetaining Wall
202 Final'Factory Fire Place
203 Final Sign
204 Final �emolition
pRTE - IN
�� ".'"'" �
I�r
CODE� INSPECTIONTYPE
206 � -Final Mec�anical � �
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site � �
250 Final Building/Occupency
� CITY OF COSTA MESA -�
"' BU►LDING DIYIS/ON
F� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wvw.ci.costa-mesa.ca.us
°•*�[ � • FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER P07-00496
PERMIT TYPE PLUM
JOB ADDRESS: 383 16TH PL CM
Vicinity: SIDE YARD
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
08/13/2007
RMD
SCOPE OF WORK: REPAIR, RECONNECT AND INSTALLATION OF ADDITIONAL GAS PIPING FOR UNIT B, LOCATED AT SIDE
YARD.
OWNER: EWING, CAROLYN PEIRCE TR
PHONE: 916-660-9545
APPLICANT: GOMEZ, JOSE
PHONE: 714-875-4429
CONTRACTOR: NIC BECK'S PLUMBING CONTRACTOR
Address: 6391 CORNET CIR
City/State: ANAHEIM, CA ZipCode: 92807
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $33.30
TOTAL FEES: $33.30
Address: 2280 PEGGY LN
City/State/Zip: EL DORADO HILLS, CA
Address: 6391 CORNET GR :
City/State/zZip: ANAHEIM, CA
License No. 580929
�PHONE: 714-875-0429
CELL:
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 7, 72-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS fROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this permit.
LO�ER INSPECTIONTYPE DRTE INTf11AL5 CO�� INSPECTIONTYPE OAT INTIIIALS
1676 Fixed System Final Fire Prevention 206 Final Mechanical
t286 Pool Spa Final 208 Final Plumbing R-IG. -c�� �_
200 Final Re-Roof 210 Final Electriwl
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final BuiidingiOccupancy
WORKERS' COMPENSATION DECLARA710N:
I hereby aKrm untler penalty o/ perjury one o!!he /ollOwing declarations:
❑ I have antl will maintain a certifcate of conseN to sel4lnsure (or workers'
compensalion, as provided for 6y section 3700 of the Labor Coae, for the
peAormance of t�e work for which t�is permit is issuetl.
❑ I have antl vnll maintain wnrkers' compensation insurance, as required 6y
sec(ion 3700 of the Labor Code, for the pedortnance o( the v.ark fw which this
pertnit is issued. My �wrkers' compensation Insurance carrier and policy
number are:
Carrier.
/fis secfion �eedror ee mmyetedlme perma B mC�edat me huntlreedanaislS�0o1 akss)
POlicy Number:
I certify thal in the peAormance o( I�e work (or which this permil is
C ssuetl, I shall nol employ any person in any mannei so as to hecome subject
to ihe workers' compensation laws of Catifomia, anA agree fhal if I shoulA
bscome subject ro the vrorkers' compensation provisions of Section 3700 of
ihe Labor od , I shall lorth �th comply vrith these provipsions. t��
L'7'' �'� T
Cpit9nl'9Spn9Wre �Oate'
WARNING: AIL RE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUT AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDREO THOUSAND DOLLAF2S
($Y00,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CON7RACTORS DECLARATION:
� hereby aKrm (bat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0l the Business antl Protessions Code, and
my license is in fu�ljl force antl eHect. J
Lic. # � D � � � Crlass # / C-` � �C
_ F!_L� o ,•�—
� Y uanarsSigreWre `_Date
CONSTRUC ON LENDING AGENCY:
❑ 1 hereby affum that there is a crostruction IerMing agency fw the
peAormance of the v.ork fv which tNs permit is issued. (Sec. 3097, Civi7 Code).
Lender's Name:
L@ntler's Address:
SiB�aWre Date
OWNER•BUILDER DECLARATIONS:
I hereby affirm that under penal�y ol perjury that I am EXEMPT PROM THE
CONTRACTORS LICENSE LAW (or the (ollowing reason (Sec. 7031.5.
Bbsiness and Prolessions Code: Any city or counly which requir05 a permil lo
consWct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ihe appliwM for such pertnit to file a signed statement
Ihal he or she is licensetl pursuant to the provisions of lhe Contrectors
Li�ense Law (Chapter 9(commencin9 wilh Section 7000) of Division 3 ot Ihe
Business and Professions Cotle) or that he or she is exempt therelrom ana
lhe basis for the allegetl exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects Ihe applicant ro a civil penalry of not more than
fve huntlred dollars ($500).):
❑ I, as owner of lha propeny, or my employees with wages as lheir sole
cOmpensation, WILL DO THE WORK, antl the strucWre is not intended or
oHeretl for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law aoes not apply to an ovmer of property who builds or improves
lhereon, and who dces such work himself or herself or through his or her own
employees, provided that such improvements are not intended or oflered for
sale. If, however, tha building or improvement is sold within one year of
completion, the rnmer-Duiltler will have the burden of proving Ihat he or she
did not build or improve for purpose of sale.).
[] 1, as owner of the property. am EXCLUSIVELY CON7RACTING WI7H
4CENSED CONTRACTORS to conSWCt lhe projecl (Sec. 7044. Business and
Professions Cotle: The contractps License Law dces not appy to an o:mer of
propeny vfio builtls or improves thereon, antl who cmtracts for suCh project with
a contractor(s) license pursuant to the Contractors License Lav+s.).
[� I am exempt under sec. �
Business antl Prolessions Code for this reason:
SignaWre Date
7057-46(3/07)
Ovmer ID verifed by drive� .nse. ❑ Yes ❑ No
Oriver's License No. Expires:
Venfication of Ownership by (type of document, i.e. - property lax bill or tleed):
OIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby ceAily thal no excavation frve (5) or more feet in depth into wfiicfi a
pereon is required to tlescend, will be made in connection vrith work authorized
by this pertnit, and that no builtling sWCNre, scaffdding, (alsework, or demolilion
or dismantling thereo(, will be more than thirty-s¢ (36) teet high. (Chap. 3.2, Grp
Z. AM1 Z. Sec. 341, Tdle 8. Califomia Administ2tive Cotle).
� As ovmer-builtler, I will not employ anyone ro do wnrk which woultl
require a pertnil lrom the Division of Industrial Sa(ety, as noted above, unless
such person has a permit to tlo such vrork from the division.
AodiwNS SipnaWre
Division of Intlustnal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fulure builtling occupant need to file antl
ceni(y a Business Plan for emergency response to release or threatenetl
release of a hazardous material? � Yes ❑ No
�Section 25505 ot 1he California Health and Safety Code requires, with some
exceptions, that a Business Plan be fletl with the Costa Mesa Fire
Depanment by every business which has at any one time dunng a reported
year a quanti�y ol hazartlous materials equal to or greater than a vreight ol
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlard temperature and presswe).
2. Does or will lhe applicant or present or future building occupant neetl to file
a registralion form lor acutely hazardous materials7 ❑ Yes ❑ No
(Sedion 25533 of the Califomia Health and Safery CoOe, with some
eaceptions, requires registration with Ihe Costa Mesa Fire DepartmeN by
each business which at any one lime has on hantl a quantity o( acutely
hazartlous malenals equal to or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at standard
temperature and pressure).
3. Does or will the applicant or preseM or tuture building occupant need to
prepare an RMPP (Risk Management antl Prevention Program tor acutety
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery CoCe proviCes that the
Costa Mesa Fire Department may require the prepa2tion, certification antl
filing with lhe Fire Department o( an RMPP by businesses which are requiretl
to register acWely hazardous materials vrith the Fire Department.
4. If an RMPP is presently require4 has Section 25534 of the Calilornia
Health and Salety Cotle been fully complied with? ❑ Yes � No
5. Does or will the applicam or present or fumre building occupant require (or
me vrork which is the suDject of this applicalion a permit (or such consiruction
or motlif�tion (mm the South Coast Air Quality Management Dislrict or from
any other air polNtion control district or agency? ❑ Yes ❑ No
(Section 658502 0l ihe Cali�omia Govemment Code requires that the requesled
intortnation De lumished on applications fer non-resiGential builtling permits).
6. Will any paA o! the lacility to be conslructed under this pertnit be within
7000 feel from the outer bountlaries of a school7 ❑ Yes ❑ No
(II'yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. II a pertnit Irom tha South Coasl Air Quality Management Dislnct or other
air pollution comrol district or agency is required for the work which is the
subjecl ol this application, have all of t�e disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been matle? � Ves ❑ No
8. Q! yes", attach cenficate o( compliance from the appropriate air polNtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
inlormation given above is correct I agree to comply with all state laws and
ciry ordioa�ces regarding Hazardous Materials and Emissions_
s�gnawre Daie
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cenify under penalty o( perjury that I have read this application and state that
the information given is correcL I agree ro comply with all state lavrs and ciry
ordinances relating lo building consWction, and aulhorize representatives ot
the City of Costa Mesa to enter upon the above-tlescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed by this pertnit until Lnal inspection.
Sig at reo(Legal er(5) Da�e
An o� utn� �I � _��
OO�i�M' � Daie -� /
1
�
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AVo���ant to /ill in all soaces excev< <�ose within neavy Gortler Iines ane sign al1 aoorooriata tleclarations.
CITY,OF COSTA MESA CON RUCTION PERMIT PERppF"j y,Q,� „^ry) TRACT NO. LOT NO. UNIT NO.
Project Addresi ��s�3 /G T� P/a GQ
Applicant's Mailing Address
Owner's Name Phone �
Address 3.� 3 � �O %� . /
Arch/Eng. Licenu No.
Address /'
Contracror's NamHa PNE /L ¢� �tlS 7�} ILPhone
Addresslmailing) Li..SS�� %��"S% Q��� bi�t-L
Ciry Licenu No. �%� �_G� �S'?i C�
LICENSED CONTRACTOR DECLARATION
I hereby afflrm tha� I am Ilcensetl untle� p�ovision5 of Charter 9(commencln9
with 5ection ]000) ot Dlvision 3 of the Business antl Proteisions Code, antl
my Ilcensa is In fu11 f, e fecL � p
LICBO52 355 I I15 NO. � S /
Date � _ Signature
WORKERS'COMPENSATION DECLARATION
I here�y aftirm that I have a certiticate of consent to Self-insure ar a certificate
oi Workers' Gompensatwn Insur nce, or a ceriifietl copy tnereot (Section
100, Lab. C.) �� ` �
�licy No. � Company Y �
�Cert!fietl �opy !z fertlbwitltrtnehc ty B�Itl g vi ion (/}�'
Date APPlicanl ���� � �� ��'
EXE PTI N F �ORKERS' COMPENSATION DE ARATION
(This sec[IOn nee0 not be completetl if the permit is tor one hundretl (S100) or
less).
I terlily that in the pet(ormance Ot the work t0� which this pe�m�t is Issuetl, I
shall not employ any person in any manne� so as [o become subject to th¢
Workers' Compensation Laws of California.
Date Si9nature
NOTICE: H, atter makin9 this tleclaration, you zhoula become subject to tne
Workers' Compensation provision5 Of lhe l.aEor Gotle, you must fortbwith
comDly with suCh proWsions or this pe�mit sttall be tleemetl revoketl.
CONSTRUCTION LENOING AGENCV
I hereby aifirm that Ihere is a consttuciion Ientling a9ency tor the periOrmanCC
of the work lor w�icb tbis permit is issuetl (Section 3097 Civ. C.)
Lantler's Name
LenOer•s Atltlress
OWNER BUILDER dECLARATION
I hereey a/firm thal I am exempt from the Contractor's Licenso Law lor ine
tollowin9 roason (Section 7031.5 Businezs and Professional Cotle: Any tity or
county wnlGh rlqWres a pe�m{t t0 cOnztruct, alfer, ImprOve, demolish or rapal�
any structure, prlor to its issuance, also requires the apo���ant for"sucn permlt
to file a slgne0 Stalamenl [hat he/s�e i5 Iitensetl pursuanl to Ihe prOvisioni ol
the Contractor's Licenze Law (Chapter 9(commentlng with Sactlon 7000) oi
Dlvision 3 of lhe Business antl Prafesvons Cotle) or thdt h0/she is exempt
Iberofwm and the basi5 tor the allegetl exemptiOn. Any vlolatlon ol SeGtlOn
-`31.5 Dy any applitant tOr a permit SUDjects [he ap0��<dnt to a clvll
dlty of not mor¢ Ihan tive huntlretl tlollars (5500).
1, as owncr o/ �he pro0erty or my em0loyee5 with wages as lheir So10
compensation, will Ao the work, antl Ue siructure is nol intentletl or oHoretl
for sale (Soction 7044, Businest antl Protessional Cotle: The ConVactor'S
Llcensc 1. w aoes not aoo�Y �o an owner oi a properry who builtls or Imoroves
lpmaon, antl wh0 UaGs such work himsell/M1crself or [brough �is o� har own
employ Cos, provitletl lhat Such imOrov<mCnts are no[ intentletl o� olleratl for
sale. I1, nowever, Ihe bulldln9 or improvement i5 Toltl wltnin ono yoar Of COm-
pletion, lho owner will nave Ihe burtlen o� proving he/sha tlitl not Dulla or im-
prove lor t�e purpOse ot sale).
❑ I, ds owner oi tbe properry, am ¢xclusively contraCting with Ilcen58tl Wn-
tractors to construct tne project (Section 7044, Buziness antl Protessions Cotlo:
Tha Conlractor's Li<ense Law does not ap01y to an owner Ot pw0erty who
builtls or improves lhereon, antl who conVacts lor zuch proje<ts with a Con-
tractor(51 bcense pursuant to Ihe Contractor'i Ucense Law). I am aware tha[
prool o( tneir WorkeYs Compensation insurance 5houltl ba Orovitletl to me.
❑ I am exempt untler Section B. & P. C. lor tnis reason
Date Owner
I hereby certity that 1 nave reatl ihis application antl state that tne above
Information is corretL I aaree to comoW wi[h all cilv antl countv ortlinances
Signature
Drivers' L
CMF OB65-4fi, rev. 10/84 White
TYPE OF CONSTRUCTION LJ NEW LJ NDD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH Q OTHER q,p, q�
DESCRIPTION OF WORK/USE OF BLDG.
S Main Bu
TYPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL A Rear
❑ OTHER
PROJECT DESCRIPTION 5�. FT. oCCUPANCv .0 Right
K Lett
CONSTRVCTIONTYPE VALUATIONS $
ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: Planning No
3ar Sink
3acktlow Preventer
3ackflow Irrigation
3athfubs
Claritiers
�ishwasher
�rinking Fountains
'rloor Drains
Floor Sinks
uasService OuUets
IOf2fC2{ltOIS
Ki�chen Sink
Lavatories
P—Trep
Root Drains
Reinspection Fee §75
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Mul[iple ❑
FirepUFact Blt. IC80 �h
Heating System & Ducting
�0.100,000 BTU 0100,OOOBT'
�/,
nq; Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor
Showers
Service $ink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Poo� w/Spa
Urina�
Weter Closet
Water Heater
Water Service
Auto�Wash
laue Fae
Hood or Type I �
Cunopy Type II ❑
Refrigeration System
�0.100,OOOBTU ❑100,000
System RepaiAAlteration
Fire Dampers
Registers
Isue Fee
FEES
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW �5�1
Zona
Accessory Building:
i U000 07S-OOfl04Q75 T��T
Parking Req./Provided
ELECTRICAI
Transformer � 15�50 KW
❑ SO+KW
Meter �up to 100 amps
Me[er pover100amps
Sub Panel
Motors �0.1 HP �i'f, - 8
Int. Solar �9�15 HP �16�15+
Microwave
Pole Light
Range
Standing Sections
KW Trash Compactor
5 3 I
�- Rainspection Fee $15 luue Fee
FEES
DEV ELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Buiiding ApproVed By
Aooliration Issued BV � �
$ 3
E
N
I
N
G
R
E
�
M
T
S
FEES
$ 3
SUMMARY OF FEES
BUILDING PERMIT $ SMIP S
PLAN CHECK $ PERMIT
PLUMBING $ � ��UANCE $ �
PLAN CHECK 25% $ ENERGV P.C. $
EIECTRICAL S GRAD�NG 5
PLAN CHECK 50% $ MICROFILM 5
MECHANICAL S TOTALFEE S �r �
PLAN CHECK 25% $
CONSTRU6TION AND P,LANNING POOL & SPA
APPROVALS' Perfiit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary�Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms C�
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding "`
5. Steel Reinforcement 56. Rough Plumbing & Pressure�fest
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUIVITE
7. Footings � �' � 58. Electrical Conduit-Undrgrnd :�
8. Foundation � 59. Gas Pipe, O Undrgrnd., TestL:
9. Water PipE'�Jndrgrnd. , 60. Backwash Lines, P-Trap, O Uridrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK ��
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap . 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electriral-Conduit 66. Solar SYs[em-Final
16. Rough Electric Wiring 67. fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
76. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing � � 73. Undergrnd.StorageTank OGas ❑Oil .
25. Roof Sheathin9 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 't+
27. Frame and Flashing � 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT r
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � y
33. Final Electric Notes: �
;!
n r
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing � '(� �b` (�� • .
39. Water Service-Final • •
40. Gas Service-Final �
41. Solar pomestic-Final "
42. Backflow Preventer • ' '
. �•
43. Backflow Irrigation ��
44. Landscape Irrigation System • . ✓
i
45. Sound Attenuation ,��
46. Handicap Regulations �
.,.�
47. FINAL STRUCTURE & BUILD�NG .;;
.:
48. Special Requirements Comple[ed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY . ,
No. Date
.y , �� t .
CITY OF COSTA MESA PLANNING ilEPARTMENT
A.P. No.
Bldg. Perm'
�
� OCT 26-7?�-A'—°007215Ro*`
, C�qSh �iZZ0.00
ppgg [�iD RECREATIONAL FEES - Apartment Developments
Fee Payment Receipt
Project Address
.. . �, . .
Owner's Name
:.. ., � � .
Bachelor or 1- Bedroom Units @$25.00 =
2 - Bedroom Units
$40.00 =
3 - Bedroom Units @ $55.00 =
4 - Bedroom Units @ $70.00 =
5 - or more Units @ $75.00 =
Total Number of Dwelling Units
322a.+3u
Total Fee +�'-IJ•00
Planning Department Approval Date � Park Area No.
+ ^ J•"/G (;
gy M.�.U. 11C:! Applicant's SignaQ`ure �
\
�'OWNER WARMINGTON,.Robert C. . DATE 10�26�72
�� �pB ADDRESS 3 3 E. 1 th Pl. BUILDING PERMIT N
r GENERAL CONTRACTOR Robert C. Palmer DESCRIPTIONofWORK are6e
� ' Vo. 117-271-
ECTIONS
�J SO�L
_� GAS
W pTER
RtlUGH PLUMBING
PRUP. SWR. LINE Q M
SPRINK�ING SVSTEM
MISCELlANE0U5
ROUGH HEATING ANO AI
TEMPORARV SERVICE 0
UNDERGROUNO, P
ROUGH WIRING
TRENCNES FORMS
FLOOR SYSTEM
BOND BEAM � STE
SMEATMING
FRAME AND FLASNING
LATHING - IN i
PLPSTER, BROWN COAT
TURAL, FINAL
H. . iNG. VENT., REFR
PLUMBING, FINAL ANp
ELE�TRIC, FINAL
Bl11LDING. FINAL
TRACT FI
SUBCONTRACTOR
tlWNER y1��GTON, Robert DATE 10
JOB ADDRE55 g$3 E. 16th Pl. r,,:,,,e1 pia� � BUILDfNG P
FIRE ZONE VALUE
GROUP I TYPE
SUBCONTRACTOR
H NEATING AND AIR CONDITIONING
UNDERGROUN� ��/J POWEH
RO�GN WIRING
BON� BEAM �� STEEL REINFORCE
SNEATHING
FqAME qND F�ASHING,
LPTNING — IN � OUT
P�^�TER. BROWN COAT
Tl1RAl, FINAL
Hb..i ING, �ENT., REFFIG. l
PLUMBING. FINAL AND GAS
oill� 111Nf. FIIJAI
( f�
/ � .
- � 35 05
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicant to Fill in Completely u ��T�
BUILDING � A/-
ADDRESS � C � /'(,./j C
OWNER �{� t `/+� j } O �'1
MAIL /'
Z AODRESS � O !��'T I� (�
dU CITV G✓ yrT NOL�(/t�g���
Z Q CANSTRUCTION
ON LEN�ER Gi�i C'� FG
am �
J � BRANCH �
J V1
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PpIG � +,�£t�it
ecr —2-n�,y�:.00 ooa. 6Q.63
TION FOR BUILDING PERMIT
A.P. NO. ��� ^�� .�� P�
BUILDING • � �
ADDRESS
TRACTy�N75 � LOTSEa
OWNER
Jm ARCHITECT R�DAM�• TEL. S' I���
a ORENGWEER LJ e.�:�,N .G�fL� II
V N L ! FIRE
w� ADDPES T •S{/ M! � ZONE
d W e%'� APPROVED
J O CONTRACTO - _
mZ 2025 � � o
J � ADDRESS
0 /� TEL. 7f y(Qj
Z� CITY Cir •( ��(/� NO. C
� STATE CITY
? O LIQ NO. 2� r L OQ LIQ NO.
SIZE � �/ O NO.OF BLDGS.�
OF LOT Z j� I NOW ON LOT
VSE OF �
EXISTING BLDG.
20Ne NO.OF ,
P�� c
- -VARDS APPROVED
F' SI2E OF n NO. OF ^
Z NEW BI.DG. C� s�� ROOMS I STORIES OC L.SIDE FT.
a EXTERIOR WALI I_ ROOF S N�k� ,
�% COVERING �f�'«� COVEIiING 'FtCC REAR FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. �J
n' � MAIN BLOGS. �-1
a
Q � � VAR.#
OC.U.P. # ' • '
� APPROVED/ !!�
y 1 - V-
z
O
UI hereby acknowledge that I have �eatl this application and state
� that the above intormaiion is correct antl agree to comply wiih
� all laws regulating builtlinq consttuction, antl I shall not employ
r any person in violation of the workman's compensation laws of
y th¢ State of California.
ZI hereby certify that I am properly licensetl as a contractor under SQ. FT.
the State ot California Business antl Professions Cotle, Division 3, T E AMOUNT SH
Chapter 9, antl that such licenses are in full force antl effect, or I TNE PURPOSE OF
am exempt trom the provisions of ihe State of California Busineu VALVATION
antl Professions Co , D' ision 3, C pter .
Sipnature of ` // ` %� a�
Permlttee � $ � �
Auffiorizetl Agent � / '
VALUE
DAT
eUILDING EW j�JpCE){
VARDSAPPROVED
ACCESSOFV BUILDING
BET. MAIN &
�
m
m
O
VALVATION IS FOR �
A PERMIT FEE ONLV: m
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' $ j
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�COSTA MESA BUILDING-SAFETY DEPARTMENT
o n onv wm rncre iucce re� �cnowe o�ax
^.CT 25-72����°001208 ��**131.5D
P IC TION FOR BUILDING PERMIT
For Applicant to Fill in Campletely
RE IV D ATERCEIVED DATEISSUED
a���o�N� C — L UN�r,a o- - o-
ADDRESS
/,�/ P RMI^ �
OWNER . (�VI��L�//�(/ A.P.NO.
MAIL BUILDING � Z T%- IN`
ADDRESS ADDRESS �� C (� (
TEL. TRACT LOT BLOCK
CITV NO.
CONSiRUCTiON W
LENDER
BFANCH
OWNER 2A.IIN
ADDRE55 p VALVE
ARCMITECT TEL. S VF L F g / Q�
OR ENGINEER N
FIRE
ADORESS 20NE TY E� GROUP
APPROVED
CONTRACTOF BV i DATE � �
ADDRESS ZONE NO.OF USEOFNEW
TEL. p�qKS BUILDING
CITV NO.
STATE CITV �'ARDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILOING ACCESSORV BUILDING
512E NO.Of BLDGS. (FROM C/LSTREET)
OF LOT NOW ON LOT FOfYT FT. FT.
USE OF
EXISTING BLOG. FT. F
SI2E OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE FT. FT.
r,
EXTERIOR WALL ROOF \ J'
COVERING COVERING REAR FT. FT.
USE OF UILDING AND WORK TO BE PERFORMED DRTANCE BET. BEf. MAIN &
� MAIN BLDGS. ACCESS. BLOGS.
Q VAR. # DATE
U r � C.U.P.�W APPROVED
APPROVED
1 hereby acknowledge thet I have reatl this epplicetion and stete � ,
Nat th¢ above information is correct entl agree ro comply with
all laws repuleting builtling consttuction, entl I shall not employ
eny person in viOlation ot the workmen's compansation laws ot
the Srote of Califomie. m
�
1 hereby certity Mat I am properly licensed ez a conttactor untler SQ. FT. O
Me Stam of California Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VA�VATION IS FOFi �
Chepter 9, antl that such licenses are in full force end etfect, or I THE PUflPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
am exempt f.om the Orovisions of the Stei¢ af California Businesz ¢
entl Protass(ons Cotle, ivision 3, Chaptar . VALVATION � � ry
PERMIT FEE $ �
SiB�atura of m
Petmittee $ - PLAN CNECK $ E
9 0`
Authorizetl ABe� . u
� TOTAL FEE $ •
' 35508 � �•
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BVIIDING � R� E I C f� � G
Cf]fIRFSS
OWNER
MAIL
ADORE
CITV
BRANCH
�.d« F C �,o �•..•'
c� o r•. � F L.•c �r
Cd
4�}Ae`e.� TEL.(��ilL(l��l
ADDRESS F12 /'J F' . /�'1 � �
I
CONTRACTOR /
AODRESS �LI L i �L %�,� � �Q' I�
TEL.�iS'Y�/ 3
CITV hI � n NO.
LIC. NO. 1. �r f C 00 LICYNO.
OFLOT �ZO K�ZO NOWONLO�
VSE OF �.`
EXISTING BLDG.
SI2E OF NO. OF
NEW BLDG. � � � ROOMS � STOF
EXTERIORWALL y�CO ROOF �N14
GOVERING S� COVEFING t
USE OF BUILDING AND WOflK TO BE PERFORMEO
� ii � � /�.i��
�
OCT -7_-7?PA��OO 007 � �.�0
<<,�, � �:���
TION FOR BUILDING PERMIT
A.P. NO. I / � � d // �
BUILDING 3j �3 1
ADDRESS
TRAZ:i� (1 � �
W
OWNER �
USE C^�ii�/-�Il �
FIRE
$.ONE TV
yOPFOVED
BLOCK
ZON NO.OF USE OF NEW� Q✓s�'�
PLAPLS � BUILOING {�rl�(�
VARDSAPPROVED YARDSAPPROVED
MAIN BUIIDiNG ACCESSORV BUILDII
(FROMGLSTREET) � n..
VAR. # OATE
�C.V.P.gW �' �APP�ROVED
APPROVEDI/li./ /"" I . /.
r— �'
I hereby acknowlatlBa thet I have reatl thls applicetion end stete �J
that the abova Intormetion is corrett end agree to cOmply with
all laws regulat(np buildinB �onstrucx{on, antl I shall not employ
any paraon in violation ot Ma workman's compensatlon lews ot
the Stata of Celitomia. � � °�
b
I haroby carNfy t�ai l em proparly Iicensetl aa a centractor untlar S�. FT. o
i
Ma Ste[o ol Californie Businau and Profeuions Gotle, Olvislon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF �
Chapter 9, entl thet such Iicanses ere in full force antl aftxt, or I THE PURPOSE OF ESTABLISNING A PERMIT FEE ON�V: m
am axempt from tha provisions of the Stata ot Celitornle Business ¢
nntl ProfosslonsCotle Division 3, Chept 9 VALUATION y
PERMIT FEE S �
�
SlBnaturo at �� � ii
Parmittoe $ � PLAN CHECK $ E
`a
Authorizotl Apent LL
TOTAL FEE $
Z .
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX t200 COSTA MESA. CALIFORNIA 92626
1CT 26-7�P�to001211 cJ,****
CR.`:: ZS.GQ
PP IC TION FOR BUILDING PERMIT
For Applicant to Fill in Completely q E o v DATE RECEIVED
DATE ISSUED
a�,�o�N� 3� � G , o� _�
ADDRESS
PE 1 NO
OWNER A.P. NO.
MAIL BUILDING
AODRESS ADDRESS � �
TEL. 7qqCT LOT BLOCK
CITY NO.
CONSTRUC710N
LENOEFi
BFANCH �) �
OWNER � N
ADDRESS VALUE ��% ON
ARCHITECT TEL. 5 � S /OO�
OR ENGINEER
FIFE ��
AODRESS 20NE T P GROUP ^'
APPROVED /� "//_'
CONTRACTOR BV OATE V ��0
ADDRESS
TEL. ZaNE NO.OF USE OF NEW
CITV NO. P�� BUII�ING
STATE CITV �'AROSAPPROVED VAROSAPPROVED
LIC. NO. LIC. NO. MAIN BUI�DING ACCESSORV BUILDING
SI2E NO.OF BLDCS. (FROM C/L STREET)
OF LOT NOW ON LOT RONT FT. FT.
VSE OF
EXISTING BLDG. T. FT.
SIZE OF NO. OF
NEW6LDG. ROOMS STORIES L.SIDE FT. FT.
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILD�NG AND WORK TO BE PERFORMED DI5TANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS.BLOCS.
VAR.� DATE
G.U.P.� pPPROVED
APPROVED
I hereby acknowletlBe Ihet I have reatl [his applicotion antl state
that the above information is torrect entl agrae to comply with
all laws reBulatinB builtlinp construcHon, anA 1 shall not amploy
any Oerson In violation ot the workmen's compensation taws ot
m
the Stata at Ca�ifornia. �
I hereby cartify that I am properiy Iitensetl as a contractor untler SQ. FT. o
the Stata of California Business antl Professions Cotle, Divlsicn 3, �HE AMOVNT SHOWN UNDER VALUATION IS FOR �
Chapter 9, antl that suc� license5 are in full forta end effect, or I THE PURPOSE OF FSI'ABLISHING A PERMIT FEE ONLV: m
am exampt from the provi5ion5 of t�e State of Cellfornie B�siness ¢
entlProfes5ion5Code,Division3,Cha iar VALVATION . m
PERMR FEE $ �
�.�f°��--.� '
s�a�e:�,e o+ m
Permittee ' i %'� $ �� PLAN CHECK $ � E
� � `o
Authorized Ap¢nt LL
TOTAL FEE $
tR
DATE
BUIL[
' owner-builder DESCRIPTION of WORK
LOT .r TRACT TTr FIRE ZONE VA
GAS
WATER
'iROUGH PLUMBING
'PROP. SWR. LINE HOUSE CON. �
�SPRINKLING SYSTEM
MISCELLANEOUS
ROUGM HEATING ANO AIR CONDITIONING
TEMPORARV SERVICB OR POLE
UNDEFGROUND � POWER �
ROUGH WIRING
TRENCNES FORMS STEEI RE
FLOOR SVSTEM
BONO BEAM ❑ STEEL REINFORCE I
SHEATNING
FRAME ANO FLASHING
LATHING - IN n OUT n
PL- '4R, BROWN COAT
51 :URRL, FINAL
HEATING, VENT., REFRIG. ANO A.C., FI
PLIIM91Nf.. FINGI GND GAS TEST n
SUBCONTRACTOR
3
, � COSTA MESA BUIIDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicanf to Fill in Completely
BUILO�NG
ADDRES$ t �' �'
OWNER t • �ry..
MAIL
Z ApDRESS � , yl{� �Ui
W W `'� TEL.
4-U CITV p.f,.+� pQA NO �y^
HZ
Z a �or�rR�c��o F S � �
O N LENDER
am / , �. /�
J � BRANCM Yi N
J �
m J ADDRESS
J m ARCH�TECT TEL.
a OR ENGINEER N
U N
Q
W 2 ADDRESS
aw
WZ CONTRACTOR V�jg�E�,• ^ �
J � P in�
m Z '
J� ADDRESS ' p� r/� ;yt s„p1 e �
W w TEI. (�
z� CITY �� y . NOSSC�-d %�
w � STATE CITY
N 2 LIC. NO. LIC. NO.
� � SI2E NO.OF BLDGS.
OF LOT�� � `,� I Z C7 I NOW ON LOT
lli� 7_7-73Pp<�003338� ���*30.50
CN_P
APPLICATION FOR BUILDING PERMIT
RECEIV )/ 'AT C IV D D TE ISSUE
�a�_ �. ��� _
`� PERM{-{{
A.P. NO. I ��� � V �-+ �/ .
ADIDRE S /(�3 —} p � G :
N� �,.kE�x%�s �- �r S� e, ,,,-.
f/y/1M«uG c�-o�5/
TJ LU�� L VAWE� /LQ�/1
l:
ROVED
�IPLANS C.�I BUILDING31� , �
VARDSAPPROVED YARDSAPPROVED
MAIN BUILDING ACCESSOFiY BUILDI
USE or .
EXISTING BLOG. �J , q�i C g�
� SIZE tlF NO. OF �
Z NEW BL�G. ROOMS STORIES L. SI�E FT.
U E%TERIOR WALL ROOF
COVEP�NG COVERING REAR FT.
J USE OF BUI�DING AND WORK TO BE PERFOIiMED DISTANCE BET.
a MAIN BLDGS.
a l' M
a O ..�A✓ i�. � �f�,r�'�f C URp �
0
N �� LG� P.PFfiOVEDw
�-
z
0
UI herabV acknowletlpa that I have reetl ihis applicetion antl stata
� Mat t�e above intormation is correct antl agree to compiy with
� all lawb reguleting builtling construction, antl I shall not employ
F any pa�son in violaiion of ihe workman's compensarion faws of
y the State ot California.
ZI hereOY certify that I am properly IicansaG as a conttactor untler SQ. FT.
the Staie ot Celit usiness entl Protessions Cotla, Divisicn 3, THE AMOUNT SF
Chapter 9, the� s h licenses ara in foll force antl effatt, or I THE PURPOSE OF
am exo t from th provisions ot Ma Stete of California Bustness
and Pr fessi DiviSion 3, C pter 9. VALUATION
Sip ture.a /ry�o� /
Pecinlnee $ L
l / . _ n - i.
C
BET. MAIN &
—2� 7 —>
��
\ 1q� / m
v ;
R VALVATION IS FOR �
u A PERMR FEE O LV: m
iJ ¢
EE $ L" � n
�
� m
=_CK g E
�7.� I LL
=E $
a